Dual Antiplatelet Therapy with Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients Undergoing Coronary Artery Bypass Graft Surgery
Background The optimal antiplatelet therapy after coronary artery bypass grafting remains unclear. We evaluated the association of dual antiplatelet therapy (DAPT) with clopidogrel plus aspirin and clinical outcomes among patients undergoing coronary artery bypass grafting. Methods and Results A tot...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.020413 |
| _version_ | 1831812900399874048 |
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| author | Jianyu Qu Heng Zhang Chenfei Rao Sipeng Chen Yan Zhao Hansong Sun Yunhu Song Sheng Liu Liqing Wang Wei Feng Shuiyun Wang Shengshou Hu Zhe Zheng |
| author_facet | Jianyu Qu Heng Zhang Chenfei Rao Sipeng Chen Yan Zhao Hansong Sun Yunhu Song Sheng Liu Liqing Wang Wei Feng Shuiyun Wang Shengshou Hu Zhe Zheng |
| author_sort | Jianyu Qu |
| collection | DOAJ |
| description | Background The optimal antiplatelet therapy after coronary artery bypass grafting remains unclear. We evaluated the association of dual antiplatelet therapy (DAPT) with clopidogrel plus aspirin and clinical outcomes among patients undergoing coronary artery bypass grafting. Methods and Results A total of 18 069 consecutive patients who underwent primary isolated coronary artery bypass grafting between 2013 and 2017 were identified from a contemporary registry, and 10 854 (60.1%) received DAPT with clopidogrel plus aspirin as determined by claimed prescriptions after surgery. Cox regression models with inverse probability of treatment weighting were used to examine the associations between DAPT and outcomes. Patients who received DAPT, compared with those who received aspirin monotherapy, had a lower incidence of a composite of all‐cause death, myocardial infarction, stroke, or repeat revascularization at 6 months (2.9% versus 4.2%; inverse probability of treatment weighting–adjusted hazard ratio [HR], 0.65; 95% CI, 0.55–0.77; P<0.001) as well as death (HR, 0.61; 95% CI, 0.41–0.90), myocardial infarction (HR, 0.55; 95% CI, 0.40–0.74), and stroke (HR, 0.58; 95% CI, 0.46–0.74). The incidence of major bleeding did not differ significantly between the 2 groups (HR, 1.11; 95% CI, 0.69–1.78). Similar results were noted across multiple subgroups as well as when using different analytic methods. Conclusions Among patients undergoing coronary artery bypass grafting, DAPT with clopidogrel plus aspirin as secondary prevention was associated with reduced risk of major adverse cardiovascular and cerebrovascular events within 6 months as compared with aspirin monotherapy, and there was no significant increase in major bleeding. |
| first_indexed | 2024-12-22T21:45:35Z |
| format | Article |
| id | doaj.art-08522f0a970a4d8a8c5624b35914d410 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T21:45:35Z |
| publishDate | 2021-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-08522f0a970a4d8a8c5624b35914d4102022-12-21T18:11:30ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-06-01101110.1161/JAHA.120.020413Dual Antiplatelet Therapy with Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients Undergoing Coronary Artery Bypass Graft SurgeryJianyu Qu0Heng Zhang1Chenfei Rao2Sipeng Chen3Yan Zhao4Hansong Sun5Yunhu Song6Sheng Liu7Liqing Wang8Wei Feng9Shuiyun Wang10Shengshou Hu11Zhe Zheng12National Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaNational Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaNational Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaNational Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaNational Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaNational Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaNational Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaNational Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaNational Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaNational Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaNational Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaNational Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaNational Clinical Research Center for Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing People’s Republic of ChinaBackground The optimal antiplatelet therapy after coronary artery bypass grafting remains unclear. We evaluated the association of dual antiplatelet therapy (DAPT) with clopidogrel plus aspirin and clinical outcomes among patients undergoing coronary artery bypass grafting. Methods and Results A total of 18 069 consecutive patients who underwent primary isolated coronary artery bypass grafting between 2013 and 2017 were identified from a contemporary registry, and 10 854 (60.1%) received DAPT with clopidogrel plus aspirin as determined by claimed prescriptions after surgery. Cox regression models with inverse probability of treatment weighting were used to examine the associations between DAPT and outcomes. Patients who received DAPT, compared with those who received aspirin monotherapy, had a lower incidence of a composite of all‐cause death, myocardial infarction, stroke, or repeat revascularization at 6 months (2.9% versus 4.2%; inverse probability of treatment weighting–adjusted hazard ratio [HR], 0.65; 95% CI, 0.55–0.77; P<0.001) as well as death (HR, 0.61; 95% CI, 0.41–0.90), myocardial infarction (HR, 0.55; 95% CI, 0.40–0.74), and stroke (HR, 0.58; 95% CI, 0.46–0.74). The incidence of major bleeding did not differ significantly between the 2 groups (HR, 1.11; 95% CI, 0.69–1.78). Similar results were noted across multiple subgroups as well as when using different analytic methods. Conclusions Among patients undergoing coronary artery bypass grafting, DAPT with clopidogrel plus aspirin as secondary prevention was associated with reduced risk of major adverse cardiovascular and cerebrovascular events within 6 months as compared with aspirin monotherapy, and there was no significant increase in major bleeding.https://www.ahajournals.org/doi/10.1161/JAHA.120.020413aspirinclopidogrelcoronary artery bypass graftingdual antiplatelet therapysecondary prevention |
| spellingShingle | Jianyu Qu Heng Zhang Chenfei Rao Sipeng Chen Yan Zhao Hansong Sun Yunhu Song Sheng Liu Liqing Wang Wei Feng Shuiyun Wang Shengshou Hu Zhe Zheng Dual Antiplatelet Therapy with Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients Undergoing Coronary Artery Bypass Graft Surgery Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aspirin clopidogrel coronary artery bypass grafting dual antiplatelet therapy secondary prevention |
| title | Dual Antiplatelet Therapy with Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients Undergoing Coronary Artery Bypass Graft Surgery |
| title_full | Dual Antiplatelet Therapy with Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients Undergoing Coronary Artery Bypass Graft Surgery |
| title_fullStr | Dual Antiplatelet Therapy with Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients Undergoing Coronary Artery Bypass Graft Surgery |
| title_full_unstemmed | Dual Antiplatelet Therapy with Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients Undergoing Coronary Artery Bypass Graft Surgery |
| title_short | Dual Antiplatelet Therapy with Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients Undergoing Coronary Artery Bypass Graft Surgery |
| title_sort | dual antiplatelet therapy with clopidogrel and aspirin versus aspirin monotherapy in patients undergoing coronary artery bypass graft surgery |
| topic | aspirin clopidogrel coronary artery bypass grafting dual antiplatelet therapy secondary prevention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.020413 |
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